- Wrist:
- Exam: flexed & ulnarly deviated
- Synovectomy:
- synovectomy is most indicates before joint changes occur;
- Flexion Deformity:
- 30 deg wrist flexion deformity can be treated by serial splinting & casting;
- wedging cast can also be used to correct the deformity w/
caution to avoid subluxation;
- Hand:
- MP synovitis is more often seen in the seropositive child;
- fingers extended, swollen, and radially deviated;
- synovectomy, repositioning of extensor tendon over MP joint, & intrinsic
transfer for tightness may be performed.
- swan neck deformity in children: treat w/ splint;
- boutonniere deformity;
- injection of tendon sheaths w/ corticosteroids often improves ROM
- tendon ruptures are rare in children and, unlike those in adults,
can be rx'ed by primary repair rather than tendon transfer.
- Shoulder:
- shoulder involvement usually occurs in
Polyarticular JRA (50%) & in
systemic form (80%);
- loss of internal rotation & abduction is common;
- children w/
Systemic JRA are likely to have severe shoulder involvement;
Juvenile rheumatoid arthritis.
BP Simmons and JT Nutting.
Hand Clinics. Vol 5. 1989. p 157-168.
